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PubMed2002

[Agenesis of the gallbladder].

BACKGROUND: Agenesis of the gallbladder, first described in 1701, is a rare, congenital malformation with an incidence of 0.01% to 0.04%. The condition can be associated with other and multiple anomalies. The diagnosis can be a random discovery during an abdominal operation or at autopsy, or an astonishing perioperative finding in a patient presenting with symptoms compatible with gallstone disease. MATERIAL AND METHODS: We present a young man with symptoms interpreted as related to gallstones. The preoperative ultrasound was misaprehended, describing a small, shrunken gallbladder filled with stones. RESULTS: At laparoscopy we found no gallbladder, but a small accumulation of connective tissue and a cord-like structure believed to be the cystic duct. Attempts to cannulate this structure failed. Postoperative endoscopic retrograde cholangiography (ERC) showed normal intra- and extrahepatic biliary ducts, but no gallbladder or cystic duct. Five years after the laparoscopy the patient still experiences attacks of pain located to the right hypogastric area. INTERPRETATION: Though agenesis of the gallbladder is a rare condition, surgeons and radiologists should be aware of it. Uncertain ultrasound pictures should be supplied by more advanced CT or MR techniques to avoid unnecessary operations searching for an absent gallbladder.

Adult↗

PubMed2001

[Identification of Chinese crude drug snake gallbladder by DNA molecular marker].

AIM: It is difficult to identify the Chinese crude drug snake gallbladder accurately by morphological and microscopical characteristics or chemical components only. In order to solve the problem, the technique based on DNA molecular marker was introduced into the authentication of snake gallbladder. METHODS: DNA templates were extracted from the membrane or the bile of snake gallbladder, and also from the muscle of the original animal Elaphe schrenckii. About 400 bp DNA fragments of 12S rRNA gene were amplified from the templates and sequenced subsequently. RESULTS: Enough amounts of DNA templates could be extracted from a bit of membrane or bile of snake gallbladder. The sequence of amplicons from the membrane, bile and muscle of the same individual were identical completely. CONCLUSION: The technique of DNA molecular marker could be used for the authentication of snake gallbladder and bile. The results indicate that the technique could be used for the identification of crude drugs from other animal secretion. DNA sequence analysis also demonstrated that the origins of commercial snake gallbladder were complicated and more efficient quality control was necessary for supervising the crude drug in the market.

Animals↗

PubMed1976

On the mediation inflammatory reaction in the human gallbladder epithelium.

Human gallbladder epithelium was homogenized with a view to maintaining the integrity of subcellular components. In such homogenates, N-acetyl-beta-glucosaminidase, beta-glucuronidase, beta-galactosidase, beta-glucosidase, beta-fucosidase, beta-xylosidase, and acid phosphatase were demonstrated together with phospholipase activity. All the enzymes exhibited structure-linked latency. After discarding cellular debris from the homogenate, remaining subcellular organelles were analytically separated by density gradient centrifugation. After 100,000 g for 1 hour, particles containing acid glycosidases were recovered at a sucrose density of 1.18-1.19, whereas the mitochondrial marker enzyme succinate-reductase accumulated at a density of 1.16. The bulk of sedimentable phospholipase activity was recovered with particles sedimenting at 1.18-1.19. The results are interpreted as indicating that phosphalipase is present in lysosomes of the human gallbladder epithelium. Release of acid hydrolases, in lysosomes of the human gallbladder epithelium. Release of acid hydrolases, in lysosomes of the human gallbladder epithelium. Release of acid hydrolases, particularly phospholipase A, from the gallbladder epithelium is discussed as mediation of an inflammatory reaction in the gallbladder, i.e. cholecystitis.

Acetylglucosaminidase↗

PubMed2000

Overview for the diagnosis and treatment of gallbladder carcinoma.

OBJECTIVE: To improve the recognition of diagnosis and treatment of gallbladder cancer. METHODS: Retrospective analysis of 52 cases of gallbladder carcinoma in our hospital from 1988 to 1998. RESULTS: Preoperative diagnostic rate was 90.3%, of which 12 cases (23%) were early stage of carcinoma. The total operation resection rate was 55.8%, for which only 17.8% were advance stage of carcinoma. CONCLUSION: The early diagnosis is the key factor of increasing treatment successful rate. The following are the symptoms that raise our special attention to carcinoma of galbladder: (1) Age over 50 have recurrent cholecystitis and with past history of gallstone; (2) Congenital malformation of bile duct; (3) Local thickening and irregularity of gallbladder wall; (4) Polypoid lesion larger than 1 cm inside gallbladder; (5) Atrophic gallbladder; (6) Intraluminal stone of gallbladder does not move when change in body position; (7) Regional lymph node enlargement.

Adult↗

PubMed1992

Microangioarchitecture of the guinea pig gallbladder and bile duct as studied by scanning electron microscopy of vascular corrosion casts.

The microvasculature of the gallbladder, the common bile duct, and the duodenal papilla was investigated in 20 albino guinea pigs (Cavia porcellus) using microvascular corrosion casting and scanning electron microscopy (SEM). Main supplying and draining vessels (first-order vessels) approach the gallbladder along the cystic duct. From the latter, penetrating vessels (second-order vessels) arise which pierce the muscular coat of the gallbladder body to form the plexus of third-order vessels between the muscle coat and the mucosa. Third-order vessels finally branch to supply the subepithelial capillaries, which show a honeycomb arrangement, corresponding to the gallbladder pits. At the areas bordering mucosal pits and beneath the tunicae plicae mucosae, the capillaries form glomera. These structures make the mucosal vasculature suitable for adapting to gallbladder wall distension caused by volume changes. The mucosal capillary glomera may also be involved in absorption of substances from bile, or they could act as buffer zones, counteracting the pressure which develops as the gallbladder volume increases. Venous sphincters occurring at the junction of mucosal vessels with the subjacent third-order veins may regulate blood flow in the mucosal glomera. The neck region as well as bile ducts consist of 2 vascular layers: an inner capillary layer and an outer one containing arterioles and venules. The duodenal papilla has a hemispheric shape and is interposed in the transition zone between the stomach and the duodenum. On the most luminal aspect, the capillaries of the papilla have a ring-shaped arrangement, as do the capillaries of the stomach, surrounding the mucosal glands; the remainder of the papilla is covered by duodenal villi capillaries.

Ampulla of Vater↗

PubMed1992

Sonographic evaluation of gallbladder motility in patients with end-stage renal disease on haemodialysis.

Thirty nine patients with end-stage renal disease on haemodialysis therapy with upper gastrointestinal symptoms were investigated for gallbladder motor function as the cause of their symptoms using cholecystosonography in fasting state, after a cholecystokinetic agent (BILOPTIN fatty meal) and after a smooth muscle relaxant (BUSCOPAN). Forty healthy individuals served as a control group. No significant difference was found between dialysis patients and healthy controls regarding the gallbladder area during fasting state, or the variation in the area of gallbladder during maximal contraction and dilatation. However, the patients on dialysis therapy of longer duration had stronger gallbladder contraction in response to a cholecystokinetic agent. Serum gastrin concentrations were increased in haemodialysis patients, but there was no consistent relationship between serum gastrin and gallbladder motility. The upper gastrointestinal symptoms of dialysis patients are unlikely to be due to disturbed gallbladder motility.

Adult↗

PubMed1992

Calcium in human gallbladder bile.

Biliary calcium is believed to be of great importance in gallstone pathogenesis. These studies were therefore performed to determine if quantitative and/or qualitative differences in calcium are present in gallbladder bile from patients with and without gallstones. Bile was obtained by direct gallbladder aspiration from 68 obese patients undergoing elective gastric bypass surgery. Forty-five patients had no evidence of gallstones or sludge, 18 had cholesterol gallstones, and five had black pigment stones. Gallbladder bile was also obtained from 27 nonobese patients undergoing elective cholecystectomy (19 cholesterol; eight black pigment gallstones). For all patients, total calcium ranged from 1.50 to 16.44 mmol/L (mean: 6.05 +/- 0.31 mmol/L); free Ca++ ion ranged from 0.53 to 2.83 mmol/L (mean: 1.28 +/- 0.05 mmol/L). Considerable overlap was observed between obese and nonobese subjects and between patients with and without gallstones. For all patient groups, calcium, Ca++, and bound calcium increased linearly with increasing concentrations of bile salt. No significant differences in the slopes of these relationships were observed with obesity or gallstones. In contrast, free Ca++ ion was greater in gallbladder bile from gallstone patient groups throughout the entire range of bile salt. We hypothesize that this observed increase in Ca++ resulted from increased Gibbs-Donnan forces and excess gallbladder mucin present within the gallbladder bile of patients with gallstones.

Adolescent↗

PubMed1992

The effects of extracellular calcium on prairie dog gallbladder ion transport.

Recent studies suggest that experimentally induced gallstone formation is associated with altered gallbladder absorptive function. Moreover, elevated biliary levels of calcium have been implicated in the pathogenesis of cholesterol gallstones. Nonetheless, the relationship between gallbladder ion transport and biliary calcium remains obscure. We tested the hypothesis that extracellular calcium modulates gallbladder ion transport. Prairie dog gallbladders were mounted in an Ussing chamber, and short-circuit current (Isc), transepithelial potential difference (Vms), and tissue resistance (Rt) were measured. Tissues were randomly exposed to physiologic salt solutions containing the following concentrations of calcium: 0.01, 1.3, 5, and 10 mmol/L. Exposure of gallbladder epithelium to increasing calcium concentrations resulted in concomitant increases in Isc and Vms (p < 0.001), without altering Rt. Regression analysis demonstrated a curvilinear correlation between calcium and Isc (Y = 167 + 22.5x - 1.4 x 26; p < 0.001). We conclude that extracellular calcium may be a modulator of gallbladder ion transport.

Animals↗

PubMed2004

Clinical relationship between MDR1 gene and gallbladder cancer.

BACKGROUND: The most common mechanisms of multidrug resistance (MDR) in cancer cells is the expression of an energy-dependent exfflux pump. P-glycoprotein (P-gp) encoded by MDR1 gene and multidrug associated protein (MRP) are well known proteins associated with MDR. In human cancers, the MDR1 gene expression is common in patients with intrinsic and acquired MDR. It is a major therapeutic problem in cancer chemotherapy. Previously we found that the MDR of HCC is related to MRP gene expression and initiates the intrinsic MDR. The aim of this study is to study the expression of MDR1 gene encoding P-gp and MDRl mRNA in primary gallbladder carcinoma, and analyze its clinical significance. METHODS: Immunohistochemistry (IHC) S-P method and in situ polymerase chain reaction (ISPCR) were used to detect the expression of P-gp and MDR1 mRNA in 53 cases of untreated primary gallbladder carcinoma and 12 cases of cholecystitis (archival paraffin-embedded tissues). RESULTS: The positive expression rates of P-gp and MDR1 mRNA in the 53 cases and 12 cases were 60.38%, 71.69% and 25.00%, 33.33%, respectively. There was a significant difference between the two groups (P<0.05). The positive expression rate of P-gp and MDR1mRNA were 69.44%, 83.33% and 41.18%, 47.06% respectively in tissues in stage of Nevin I-III against Nevin IV, V (P<0.05). In well, moderately differentiated gallbladder carcinoma tissues, their expressions were 79.49%, 69.23% against 50.00%, 35.71% in low, undifferentiated tissues (P<0.05). CONCLUSIONS: MDR to gallbladder carcinoma is closely related to the intrinsic MDR and it provides an important evidence to reverse the MDR by detection of the MDR1 gene. Meanwhile, MDR1 gene expression in gallbladder carcinoma is correlated with some biological characteristics, takes part in the carcinogenesis of gallbladder tissues, and acts as a valuable biomarker of prognosis.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

PubMed2004

Influence of norcantharidin on proliferation, proliferation-related gene proteins proliferating cell nuclear antigen and Ki-67 of human gallbladder carcinoma GBC-SD cells.

BACKGROUND: Gallbladder carcinoma is a highly lethal and aggressive disease with early metastasis, strong invasion and poor prognosis. Most patients with this disease are at the advanced and un-resectable stage and should be considered for palliative treatment such as chemotherapy and radiotherapy. Unfortunately, reports of chemotherapy and radiotherapy for gallbladder carcinoma are disappointing. We investigated the influence of norcantharidin (NCTD) on proliferation, proliferation-related gene proteins PCNA and Ki-67 of human gallbladder carcinoma GBC-SD cells in vitro. METHODS: GBC-SD cell lines of human gallbladder carcinoma were cultured by the cell culture technique. The experiment was divided into NCTD group and control group. The tetrazolium-based colorimetric assay was used to evaluate cell growth. The streptavidin-biotin complex method was used to determine the expressions of proliferation-related gene proteins PCNA and Ki-67 of human gallbladder carcinoma GBC-SD cells. RESULTS: NCTD inhibited the growth and proliferation of GBC-SD cells from 10 mg/L or after 6 hours in a dose-and time-dependent manner, with the IC50 value of 56.18 microg/ml at 48 hours. After treatment with NCTD, the expression of PCNA (0.932+/-0.031 vs. 0.318+/-0.023, P<0.001) and Ki-67 (0.964+/-0.092 vs. 0.297+/-0.018, P<0.001) proteins were decreased significantly. CONCLUSION: NCTD inhibits the proliferation of human gallbladder carcinoma GBC-SD cells in vitro and the expression of their proliferation-related gene proteins PCNA and Ki-67.

Bridged Bicyclo Compounds, Heterocyclic↗

PubMed1992

[In-vitro activity pattern of gallbladder muscle tissues in patients with and without gallstones--variable response to cholecystokinin, motilin and neurotensin].

Data about gallbladder motility in stone disease and stone free conditions are discussed controversially. This study is aimed at to evaluate in vitro the responses of human gallbladder muscle stripes to cholecystokinin, motilin and neurotensin. Following the results, a stratification of the "stone-disease-group" seems to be necessary: 41% of the gallbladders (stone disease) demonstrate a deep reduction in contractility to cholecystokinin ("non-contractors"), whereas 59% of the gallbladders contract in the same pattern like the controls ("contractors"). Interestingly, the majority of the gallbladders in the "contractor" group demonstrate a high spontaneous activity which is absent in stone free gallbladders. Motilin and neurotensin either do not induce any effect.

Adult↗

PubMedDate not supplied

Effect on gallbladder function subsequent to truncal vagotomy and gastrojejunostomy for chronic duodenal ulcer.

The effect of truncal vagotomy on gallbladder function and on the incidence of lithogenesis has remained controversial. A prospective and retrospective investigational study was undertaken to evaluate the effect of truncal vagotomy and gastrojejunostomy on gallbladder function. The study included a total of 76 patients and 77 controls. In Group I (Prospective group), 32 consecutive patients with chronic duodenal ulcer and gastric outlet obstruction undergoing truncal vagotomy and gastrojejunostomy were included. Group II included 25 age and gender matched controls (prospective group). Group III included 44 patients who had undergone truncal vagotomy and gastrojejunostomy 3 years or more prior to presentation (Retrospective group) and Group IV included 52 age and gender matched controls for the retrospective group. The patients in the prospective groups were followed up for a period of 1 year. An alkaline tide test was done in the prospective and retrospective group to assess for the completeness of vagotomy. Gallbladder contractile response to fatty meal and the presence of stones and sludge were noted in all the four groups by ultrasonography. There were 30 patients in the prospective group and 40 in the retrospective group after excluding patients with incomplete vagotomy. On ultrasound examination, there was no significant difference in the gallbladder volume and contractility of the study group when compared with the controls. Gallbladder sludge was found in 16 to 25% of patients in the prospective group (group I) during follow up, where as similar finding was documented in 8% of the matched control (group II (P>0.1). However, in the retrospective (group III) 10% (4 out of 40) had calculi and 20% of patients demonstrated sludge which was significantly higher when compared with the controls (p = 0.001). Truncal vagotomy and gastrojejunostomy did not affect gallbladder contractility, but it might predispose to the formation of sludge and subsequent calculi in a proportion of patients in long term.

Adolescent↗

PubMed2005

Gallbladder varices.

Gallbladder varices are relatively rare ectopic varices in patients with portal hypertension. We present here a case of gallbladder varices accurately diagnosed by color Doppler sonography. A 51-year-old woman was admitted to our unit with recurrent esophageal varices bleeding due to extrahepatic portal vein occlusion after splenectomy. Bleeding was controlled by endoscopic band ligation and esophageal varices were eradicated after the second endoscopic session. Doppler imaging showed the existence of portal cavernoma and gallbladder varices. The close follow-up period after complete eradication of esophageal varices showed no enlargement of varices of the gallbladder or complications related to them. Color Doppler sonography is a valuable noninvasive imaging technique for assessment of portal hemodynamic profile in patients with portal cavernoma as well as useful in detecting gallbladder varices. Preoperative correct diagnosis of gallbladder varices should increase the surgeon's vigilance during biliary tract surgery in patients with portal hypertension in order to avoid hazardous complications.

Blood Flow Velocity↗

PubMedDate not supplied

The effect of o6-methylguanine-DNA methyltransferase (MGMT) and mismatch repair gene (hMLH1) status on the sensitivity to alkylating agent 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea(ACNU) in gallbladder carcinoma cells.

The aim of this study was to correlate O6-methylguanine-DNA methyltransferase (MGMT) and mismatch repair gene (hMLH1) expression in gallbladder carcinoma cells with drug sensitivity to the bifunctional alkylating agent 1-(4-amino-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea (ACNU). Using 5 gallbladder carcinoma cell lines and 1 colon carcinoma cell line (SW48), the MGMT and hMLH1 status was assessed both by RT-PCR and Western blot analyses. Sensitivity to ACNU was estimated by the MTT assay. MGMT+/hMLH1+ status was revealed in 2 gallbladder carcinoma cells, MGMT-/hMLH1+ in another 3 gallbladder carcinomas and MGMT-/hMLH1- in SW48. MGMT-/hMLH1+ and MGMT-/hMLH1- cells were more sensitive to ACNU compared with MGMT+/hMLH1+ cells. These results indicate that MGMT, but not hMLH1, expression is an important determinant for drug sensitivity to ACNU in gallbladder carcinoma cells. The drug effect of ACNU, which depends on the MGMT status, was verified using xenograft tumors grown in nude mice. Furthermore, the apoptotic index of MGMT- GB-dl xenografts was significantly increased by ACNU treatment, compared with that of MGMT+ KMG-C. In conclusion, the sensitivity to ACNU was not associated with hMLH1 status, but was found to depend only on the MGMT status. ACNU might be a useful chemotherapeutic agent for MGMT- gallbladder carcinoma, which is associated with poor patient outcome.

Adaptor Proteins, Signal Transducing↗

PubMed2005

Carcinoma of the gallbladder at the Nnamdi Azikiwe University Teaching Hospital--a 5-year retrospective study.

BACKGROUND: Carcinoma of the gallbladder is often missed because of the low index of suspicion. AIMS AND OBJECTIVES: To review the incidence, pattern and outcome of carcinoma of the gallbladder in our center and to highlight the need for early diagnosis. DESIGN: Retrospective survey of all cases of carcinoma of the gallbladder. SETTING: Nnamdi Azikiwe University Teaching Hospital serving rural, semi-urban and urban communities. PATIENTS AND METHODS: Patients who had histologically confirmed carcinoma in the general surgical units of the Nnamdi Azikiwe University Teaching Hospital over a 5-year period were reviewed and, from their case notes, the following information on sex, age, mode of presentation, time of diagnosis, stage of disease, treatment given and outcome were extracted. RESULTS: Twenty-one cases of gallbladder carcinoma were seen out of a total of 692 cases of different types of cancers seen in the general surgical units, giving an incidence of 3.04%. Six were males and 15 were females, age ranged between 39 and 72 years, a mean of 55; with the peak age in the 7th decade of life. Eleven patients (52.4%) presented with features of chronic cholecystitis and had cholecystectomy. Ten patients presented with obstructive jaundice in a stage too advanced for any form of palliative surgical treatment. The outcome was good in patients who presented with features of cholecystitis but who turned out to be cases of early carcinoma of the gallbladder because after five years of follow-up, none of them has shown any features of recurrence. There was no mortality in this group and the patients have remained in good health. However, the prognosis was poor in those patients who presented with obstructive jaundice. They remained very ill, with worsening general condition. They were discharged home on request of their relations and were lost to follow-up. CONCLUSIONS: Carcinoma of the gallbladder may present as cholecystitis. It is advisable for clinicians to have this in mind before, during and after cholecystectomy. Early presentation to hospital by patients would avert delay and improve early diagnosis, early treatment, and better outcome.

Adenocarcinoma↗

PubMed2006

Dual-time-point 18F-FDG PET for the evaluation of gallbladder carcinoma.

UNLABELLED: Conventional imaging techniques such as ultrasonography, CT, and MRI are able to detect gallbladder abnormalities but are not always able to differentiate a malignancy from other disease processes such as cholecystitis. The purpose of the present study was to evaluate the efficacy of dual-time-point (18)F-FDG PET for differentiating malignant from benign gallbladder disease. METHODS: The study evaluated 32 patients who were suspected of having gallbladder tumors. (18)F-FDG PET (whole body) was performed at 62 +/- 8 min (early) after (18)F-FDG injection and was repeated 146 +/- 14 min (delayed) after injection only in the abdominal region. We evaluated the (18)F-FDG uptake both visually and semiquantitatively. Semiquantitative analysis using the standardized uptake value (SUV) was performed for both early and delayed images (SUV(early) and SUV(delayed), respectively). The retention index (RI) was calculated according to the equation (SUV(delayed) - SUV(early)) x 100/SUV(early). The tumor-to-liver ratio was also calculated. RESULTS: The final diagnosis was gallbladder carcinoma in 23 patients and benign disease in 9 patients. For visual analysis of gallbladder carcinoma, delayed (18)F-FDG PET images improved the specificity of diagnosis in 2 patients. When an SUV(early) of 4.5, SUV(delayed) of 2.9, and RI of -8 were chosen as arbitrary cutoffs for differentiating between malignant and benign conditions, sensitivity increased from 82.6% to 95.7% and 100% for delayed imaging and combined early and delayed imaging (i.e., RI), respectively. With the same criteria, specificity decreased from 55.6% to 44.4% for delayed imaging and combined early and delayed imaging, respectively. The specificity of (18)F-FDG PET improved to 80% in the group with a normal level of C-reactive protein (CRP) and decreased to 0% in the group with an elevated CRP level. For gallbladder carcinoma, both SUV and tumor-to-liver ratios derived from delayed images were significantly higher than the ratios derived from early images (P < 0.0001). CONCLUSION: Delayed (18)F-FDG PET is more helpful than early (18)F-FDG PET for evaluating malignant lesions because of increased lesion uptake and increased lesion-to-background contrast. However, the diagnostic performance of (18)F-FDG PET depends on CRP levels.

Adult↗

PubMed2006

Gallbladder volvulus: review of the literature and report of a case.

Gallbladder volvulus is defined as the rotation of the gallbladder on its mesentery along the axis of the cystic duct and cystic artery. The presence of a redundant mesentery (floating gallbladder) is a prerequisite for volvulus. The disease, described for the first time by Wendel in 1898, is an extremely rare surgical disease. The disease mimics acute cholecystitis symptoms. Because of these two conditions, preoperative diagnosis of the disease is difficult. In any case, the definitive diagnosis is made during surgery. Volvulus of the gallbladder is an acute surgical emergency that must be treated with immediate detorsion and cholecystectomy. We report a case of gallbladder volvulus suspected pre-operatively using pre-operative imaging with ultrasound. The cases reported in the literature are reviewed and the treatment of gallbladder volvulus is also discussed.

Aged↗

PubMedDate not supplied

The blood flow velocity in the wall of the gallbladder is an indicator of the degree of inflammation in acute cholecystitis.

BACKGROUND/AIMS: To determine whether gallbladder wall blood flow velocity reflected the degree of inflammation, these were measured in 2 acute cholecystitis groups treated with percutaneous transhepatic gallbladder aspiration (PTGBA) or antibiotics alone. METHODOLOGY: Six patients underwent PTGBA and 5 patients were treated conservatively. Clinical indicators of systemic inflammation and blood flow velocity in the gallbladder wall were determined. The resistance index (RI) was calculated. RESULTS: In the PTGBA group, maximum blood flow (Vmax) decreased sharply the day after PTGBA and remained at a low level thereafter. In the conservative group, the Vmax did not significantly fall until 7 days after the therapy. The RI was significantly decreased on the first to third day after PTGBA but not thereafter. In the conservative group, the RI was not significantly changed throughout the period. CONCLUSIONS: The gallbladder wall blood flow velocity indicated the degree of inflammation in the acute cholecystitis patients. The RI of the blood flow in the gallbladder wall may also be an effective method of monitoring gallbladder inflammation.

Aged↗